Transformative Medicine as one Part of Emancipatory Spirituality

March 9, 2014

One of the foci of the interfaith and atheist or secular humanist welcoming Network of Spiritual Progressives (you DO NOT have to be religious or believe in God to be a spiritual progressive) is to build consciousness changing groups in every profession. The goal: to help professionals envision what their profession could look like if the “bottom line” in their profession was not making more money and accumulating more power, but was instead at least equally seeking to maximize through the practice of their profession the fostering of human beings who gave priority to building a world based on love and caring, kindness and generosity, ethical behavior and ecological sensitivity, and awe and wonder and radical amazement at the grandeur and mystery of the universe.

What might that look like? I developed some initial ideas on this in my book in 2000 called Spirit Matters. Below, I reprint my chapter on a Transformative Medicine to give you an idea of what kind of visioning we have in mind. –Rabbi Michael Lerner

The Soul of Medicine

by Michael Lerner

There are two dimensions of medicine and health care that will be transformed when the New Bottom Line of the NSP–Network of Spiritual Progressives becomes the guiding principle for our society: how medical services are distributed, and what the content of a spiritually informed medicine will be (that is, how we sustain and repair health).

The Distribution of Health Care

Only a society with deep moral distortions would allocate health care on the basis of how much money the ill person has. Yet this is exactly the case in the United States, and to a lesser but nonetheless real extent in many other societies. There is no moral reason why people born into poverty should have less of an opportunity to have their basic health needs met than someone born into wealth.

One of the early goals of the kind of Emancipatory Spirituality supported by the NSP will be to create a worldwide system of universal health care. The underlying principle: everyone equally deserves first-class health care because everyone is equally valuable and deserving of respect. The central value to be taught: human beings participate in God’s holiness and those who work in delivering health care, creating medicines and medical technologies, are engaged in sacred work. I’ll consider the implications of these principles on distribution in this section, and on what we are distributing in the next section.

It’s not hard to visualize how a sense of human sanctity might shape our system of distributing health care. Simply divert a substantial portion of the world’s military budget to providing food, clothing and shelter to the hundreds of millions who do not have enough, and then pay for the training and salaries for doctors, nurses, public health experts, and the construction and provision of hospitals and community health care centers. Provide health education, including a focus on diet, exercise, meditation, prevention and health maintenance. Make sure all people can get health care when they need it and that they are not faced with financial burdens when they need special care for more complicated health problems.

Hasn’t universal health care been tried and failed in other countries?

No.

What does fail is when one tries to implement universal health care without giving it the full backing of the society’s resources. In that case, the failure is political. The typical scenario becomes something like this: Inadequate resources translates into inadequate health care being available to everyone equally. People end up having to wait a long time for needed services or are denied some specialized services. Everyone grumbles. Then the wealthy manage to pay doctors to offer private medical services, or they cross national boundaries to seek the services elsewhere. The remaining population grumbles even more. Then, doctors start to grumble that they aren’t getting paid as much as they would in a free market system, pharmaceutical companies stop developing new products because they can’t make as much money as they might in a free market system, and the political conservatives who wanted to prove that collective action through government would always fail start to advance the idea of privatization, which is enthusiastically backed by those who control the media and by sectors of the upper and the upper middle classes who feel that they’d probably get a better deal (more health care at a price they can afford) if the system were privatized. nd since they have the power to have their voices heard, they often manage to dominate the public debate.

Yet none of this shows that universal health care doesn’t work, only that an underfunded system creates political opportunities for discontent.

There is nothing inevitable about this. If your own family had a medical problem and only enough resources for everyone to afford to see a doctor once every two years, I doubt very much that you’d decide that the highest paid member of the family got to see a doctor every year while others were allowed a doctor visit only once every ten years. You wouldn’t go to that solution because you care too much about the members of your family. So, you’d either try to struggle to get adequate resources or you’d share the resources according to medical need. It’s only because we have not yet gotten to the point where we can truly feel our connection to all other human beings that we tolerate the current health care system.

Of course, if you assume that the bottom line of Western societies and its logic of “looking out for Number One” without regard to others is unchangeable, then any changes will seem utopian.

In the current system it’s not surprising that people who originally went into medical professions to care for others eventually get subverted into thinking of themselves as medical entrepreneurs who have skills to sell to the highest bidder and who invest their profits in hospitals, group practices, or insurance company schemes designed to maximize their wealth. It’s no surprise, in such a system, that the most “creative” (if we can use that word for people whose talents do not extend to moral sensitivity) medical professionals, biochemists, and pharmaceutical companies will tend to flow to the countries and markets where they can best maximize their own personal advantage. That’s how it is in a world with the bottom line unchanged.

But there’s every reason to believe that most of this would change in a society that actually valued the holiness of every individual and the sacred mission of medicine. In that society, people would be recruited into the various medical and health care professions because of their overflowing lovingkindness and desire to help others. There would not be any particular financial incentive–doctors would be paid enough to lead a comfortable life, as would everyone else. The special benefits accruing to them would come from the inner reward of getting to do this work. Medical technologies and pharmaceuticals would continue to benefit from innovation, because the scientists and technicians would be joyful in the opportunity to do such creative work.

There is nothing far-fetched about envisioning that motivation. The truth is, most people who enter health care and medical professions today originally approach this work from that motivation–it doesn’t have to be socially engineered into people. On the contrary, it takes a huge amount of training and indoctrination (sometimes even more than the entirety of medical school) to drum this idealism and desire to serve out of health care people, and even then it pops up residually at various moments in the lives of most doctors, nurses and other health care workers. Imagine how much more that would be the case in a world where these feelings were encouraged, not only in the medical profession, but in every corner of the society!

Fine, you might say, that is what it could look like, but how can we ever get there from here?

Well, one first step may be this: the creation of an international corps of medical care personnel who live according to these values and who donate their services to those in need of care, and are paid by an international health organization. We could take that step right now. In fact, there are organizations like Doctors Without Borders who are already engaged in this very activity.

But on a social scale, shouldn’t we put our energies into a more “realistic” attempt to reform health care, like the kind that liberal Democrats are introducing piecemeal into Congress?

I don’t think so. I don’t oppose those measures, but I do think they tend to give the wrong message: that our health care system will be made “okay” if a few more benefits are granted. The whole model is wrong: it assumes that the existing system of health care for profit can be “made to work” by kindly reforms. But from my standpoint, the system is fundamentally misguided–its bottom line ensures that decisions about allocation will always be made on the basis of profit rather than in terms of loving our fellow human beings.

The existing system of medical distribution helps instill the values that keep our society misguided. I watched this up close when I was connected to the Clintons in the mid 1990s and they attempted to build a system that would preserve the wealth of the medical profiteers while allowing greater access for all. The outcome was a monstrosity. Moreover, when this monstrosity was nevertheless still opposed by the profiteers, and then failed, the whole country was encouraged to draw the wrong conclusion: that the Clintons had been “too radical, ” when in fact their problem was not being radical (that is, oriented toward the root problem) enough. They fought for a compromised goal, and did not even win that–in part because people always find it harder to rally around a compromised goal.

The large health care insurers and profiteers have fought every attempt at minimal health care distribution reforms by buying television ads purporting to show ordinary citizens talking to each other about how misguided these reforms are–as though the companies are really trying to champion the interests of ordinary citizens. Ironically, they put as much energy into fighting every little reform as they would into fighting a serious ethical transformation of the system. But this should teach us an important lesson: it will take almost as much energy to get minimal reforms as it will to get a rational and moral system of distribution, so it makes more sense to fight for the greater cause than for the lesser. So, the first step is not to fight for the minimal programs of the liberal Democrats, but to fight for a new way of thinking about health care that places the sanctity of human beings at the center of the debate.

Holy and Holistic Care

Once you understand that human beings are fully integrated into a mind/body/psychological/spiritual/communal totality, you begin to see that it’s not just the way we deliver health care, but what we deliver, that needs to change. If each of us is all these interacting dimensions, mind as well as body, spirit as well as emotions, then when we get sick, eery aspect of us needs healing.

The dominant model in health care today is one that focuses on the bodily level and works on it as though it could be understood separately from the well being of the whole.

Even “holistic” health approaches tend to add just one or two more levels, but avoid working on all levels in an integrated manner. This is a deep mistake. I’ve met holistic healers who work on the body as a holistic system, but know little about the emotional reality of the person with whom they are working. I’ve met talented people who talk about the energy fields around their clients, but seek no information about the family life or communities in which these people live. I’ve known Reichian therapists who focus on the way that feelings get embedded in the bodily tissues of their clients but who are unaware of other aspects of bodily functioning and unaware of the inner spiritual lives of their clients. I’ve met spiritual healers who don’t know much about the emotional lives or social realities facing their patients.

A holy approach to medicine and health care will be holistic in the widest possible sense. It will seek to understand, diagnose, and intervene on all levels of our being at the same time. People will be seen by practitioners who have multiple levels of knowledge, and by teams of health care workers who together bring a broad interdisciplinary approach to the process of diagnosis and treatment.

The Healthy Environment

What we take in, through our stomachs, through our lungs, and through our pores, has a powerful impact on our health. It’s no news today that environmental conditions are central to our health. The air we breathe, the water we drink, the clothes we wear, the products we use to clean our bodies and our hair and our teeth, and the food we eat have become so filled with carcinogens and other poisons that we are constantly at risk.

The people who perpetrate this are not evil people–they just are living according to the bottom line of contemporary society. If they changed their minds they would be fired and someone else would be hired to take their place. Only a new bottom line will change this.

Health care must address all these issues, not split them off into realms remote from the everyday practice of medicine.

There’s also the responsibility of the consumer to buy healthy products once they become available. But don’t blame consumers who don’t have that option, or have it only if they are willing to pay more for a healthful tomato than they could reasonably afford. Responsibility begins when the options are made available. When healthy food costs twice or three times as much as unsafe food, those who can not afford to buy the better food don’t deserve to be disdained. Some upper middle class people tend to perceive themselves as saner than the rest of the population in what they eat, whereas in fact they are only richer.

Yet there are also consumption habits that need to be healed.

Many people overeat, and do so to offset the emotional, ethical and spiritual distress in their lives.

Many people frenetically engage in buying consumer goods, and then updating them whenever a new model becomes available. They find momentary consolation in the buying. But it never lasts very long.

You can never eat enough to feed a hungry soul.

So the solution is to address the spiritual hunger. Instead of taking dangerous diet pills or quick fixes, we need to provide the emotional, ethical and spiritual nurturing people need–so that they don’t take their pain out on their bodies.

A healthy environment will be one in which people have meaningful work and live in families and communities suffused with love and solidarity yet allowing for privacy and for each individual to choose his or her own path. It will be an environment in which people are rejoicing in each other’s being and supporting each other’s emotional well being, spiritual growth, and intellectual depth.

The healthy environment will have healthy foods, unpolluted air and water, and it will have repaired the sources of global warming. It will have mass transportation and a careful use of the planet’s energy and resources.

The healthy environment will give people many opportunities each day to exercise, to meditate, to sing and dance, to engage in aesthetic creativity, to do physical labor as well as mental labor, to be with others in community and to be alone in moments of quiet, to celebrate the universe in community and to connect with God in privacy.

A health care professional will be involved in addressing all these issues, and will always understand the integral nature of health.

The Holy Hospital

Imagine a hospital as a holy place in which all we’ve learned about the integrated nature of body, soul, mind and emotions is brought to focus on healing people who are in need of healing. In such a context, doctors and nurses mix with spiritual and emotional healers, with community organizers and family therapists–all dedicated to bringing the most sophisticated understanding to bear in the service of restoring health. Which professional would take leadership in shaping the particular team of healers to fit the needs of the client would depend on the particular case. There would be no hierarchy of pay or professional status, since all would be recognized as making equally important contributions to the well being of the client.

Now imagine a hospital work shift. All of the healers might assemble for a quarter hour of meditation and prayer in which they recommitted themselves to their holy function. The pressures of work can easily distract the health care practitioner from remembering the tremendously important spiritual task they face, so these moments of reconnecting to one’s highest spiritual insights would help shape the dynamics in the coming work period.

Patients would understand also that they were in a sacred space populated by professionals and lay people who chose to enter these professions in large part because of their combination of talents, spiritual centeredness, and ethical dedication. I do not necessarily have in mind, though, that it would feel like a traditional church or synagogue, with hushed and respectful tones (though I’m not sure a church or synagogue should feel that way either)–because part of a healing environment is music, humor, and entertainment (yes, the hospital would have dramatic presentations, live music, poetry and fiction readings, art, etc.–all supplied by the surrounding communities whose volunteer efforts would pour into schools and hospitals), as well as religious services, meditation rooms, and other aids to spiritual healing.

While many patients need peace and quiet and have no interest in connecting to these activities, others will be able to find this outpouring of love and caring to be healing and regenerative. Indeed, the hospital will become one of the highest embodiments of loving energy, and that love will occupy a central place in the healing of the individual.

“Wait,” you might object, “I don’t want love, I want a skilled surgeon, and I don’t care about his or her mental state.” I understand the feeling, and I felt that way myself until I recently underwent surgery and found that these other factors mattered a great deal, not only in the unnecessary delays of the surgery that made the whole process more dangerous, but also in the whole recovery process in the subsequent three weeks in which I was hospitalized. Just talk to anyone who has been through the hospital experience today and you begin to learn that having a skilled surgeon is a necessary but not a sufficient condition for effective healing.

ut where are you going to find medical professionals who could be healers in a holy hospital? Today, it would be quite a stretch. But we need to redesign medical training so it includes this way of thinking about health, and a whole new way of treating medical students. Today, medical students and interns are treated as though their lives and feelings are irrelevant; they are asked to sacrifice themselves for the sake of the hospital. In a spiritually shaped medical school, the well being of the healers becomes an important focus, and training, rotations, internships and residencies are designed not to exploit the novice, but to help her or him enter a holy sphere of work. From the beginning, this means developing in the medical student, intern and resident, nurse, social worker, chiropractor, doctor of homeopathy, and all other healing professionals an ability to pursue his or her own spiritual development and time to do so, and to hone his or her capacity to be loving and caring.

Many of the people who enter the healing professions today wish that they could develop their capacities for caring and loving, but find that it these are undervalued and even cynically dismissed at various internships and residencies. Far more will be attracted to health related careers, even though the pay will shrink, once we have a new spiritual orientation to the practice of medicine.

Meaning as Medicine

Practicing physician Raphi Kelman, M.D., has made some important observations about the centrality of spiritual meaning as a source of healing. The need for meaning in our lives has significant physiological consequences. Kelman says that his research as a medical practitioner confirms my argument that the need for meaning is as significant as the need for food or economic well being.

Spirit Matters–because the deprivation of a spiritual dimension to our lives and the absence of a sense of meaning has drastic physiological consequences.

So, Kelman argues, if one lives in a society in which health care is available to some but not to others, one is living in a society in which the sphere of caring has been severely restricted–and that will have immediate health consequences. When people are just out for themselves, there is an inevitable loss of meaning. Conversely, if we live in a society in which people take care of each other, which would certainly manifest in adequate health care being available, then we will have direct health benefits that flow not from the availability of the care but from the framework of meaning that promotes our well being.

Similarly, Kelman continues, caring about the environment is good for our health, even when we have not yet succeeded in stopping the polluters or restraining those who are misusing the earth’s resources. My very concern, and involvement with others in this issue produces the health-inducing meaning with its positive consequences.

Many people think there is a clear separation between what we do as individuals and what the country or the larger economic and political sphere is like. They imagine there is no point in bothering to try to change the larger picture. But, Kelman maintains, “What I’ve learned in my medical practice is that when someone activates the concern in themselves for ecological improvement, they are simultaneously activating a transpersonal aspect of one’s being that aspires to meaning which has significant physiological effects. So even when we can’t win on ecological change or health care change, being so engaged can have positive health effects. “

Kelman emphasizes that the issue is not just social change activity, but the inner reality that produces this activity. As American politics has become narrower and technocratic in focus, many people begin to address health care, ecological change, or other social justice issues with a kind of mentality that is more like an intellectual game than an act of love. If your involvement in these issues reflects an ability to transcend ego and connect to a life of meaning aimed at the well being of all, you activate the heart in ways that have significant impact on our physiology. So it depends on the consciousness that one brings to social transformative activity.

The reason some people might be shocked to hear this is that we have come to think of ourselves only as machines. Our materialist philosophical framework is so entrenched that it seems almost incomprehensible to us to recognize what most people throughout most of human history recognized, namely the deep connection between spiritual and physical well being.

Ironically, most of the people who tend to dismiss spiritual insights on scientific grounds actually have little familiarity with the latest developments in science, developments which make us question the wisdom of seeing the world from the standpoint of matter. The mechanistic world view has little plausibility to those on the cutting edge of physics today, yet it continues to dominate the kind of science that is taught to doctors and that is popular in the larger society. Popular attitudes on science today fit with the science of fifty years ago.

Medicine, Kelman points out, got into this error a long time ago. It developed its “medical science” through the study of the anatomy of a corpse. Much important information was gathered, but deep philosophical mistakes accompanied the new knowledge. A human being is not a corpse–we are something that needs to be understood in a different way. Mind and body are not separate entities–and we need to rethink our philosophical frame.

Similarly, it’s sometimes helpful in medicine to compare a human heart to a mechanical pump. But it’s fundamentally different from a pump–and indeed unlike anything we know of in the rest of the universe. We know that experiences of compassion and tolerance impacts cardiac function; but a computer or a mechanical pump won’t change its function even if it looks like it’s experiencing compassion while a human heart will change! Numerous studies show that compassion and tolerance improves cardiac functioning, whereas anger, intolerance and hostility worsens heart functioning.

It would be better to think of health as a flowing of energy that may occasionally get blocked.

At the annual meeting of the American Psychosomatic Society, medical researcher Margaret E. Kemeny, Ph.D. recently reported that a group of 330 people infected by HIV were followed for seven years. Six were found to have remained healthy while the rest proceeded to AIDS. Psychological questioning revealed striking differences between those people who had remained healthy and those who had progressed to AIDS. Those who had remained healthy were found to score much higher in the areas of Meaning, Creativity, and Giving and Receiving Love!

In the Study for the Advancement of Medicine in 1995 researchers showed that when patients experience caring and compassion, salivary SIGA, the body’s first line of defense against viruses and other pathogens, increased significantly. A study by McLellan at Harvard University. showed that an experience of compassion raises SIGA–even in people who claimed that they had no subjective feeling of compassion. On the other hand, experiences of anger suppress immunological responses and reduce cardiac functioning. One qualification: anger for the sake of humankind or to express that you are being hurt or oppressed can be healthful anger.

When people see their interconnectedness and overcome their alienation, their stress is reduced in a good way–other forms of stress reduction that really don’t have this impact. The stress reduction groups that have a positive impact are those in which the experiences of compassion, caring for each other, and interconnectedness are generated, and it is these aspects of the group that make their stress reduction work.

Kelman’s work has important consequences for medical practice: “If we can’t get patients to activate their interest in meaning (however they define it), we will not be as successful in healing. So this should be a high priority for medical practice (of course, not in circumstances of acute crisis, but in most other circumstances).

“Of course, I don’t deny the physical dimension either. Spiritual healing doesn’t have to be counterpoised to chemotherapy. We need to approach people on all levels because interventions on many different levels all have a synergistic effect. But neither is approaching someone purely on a physical level adequate. And I say this not only about the traditional forms of medicine, but also about the “alternative medicine” techniques. If you give people a regimen of vitamins or other physical interventions like nutrition that are separate from any meaning-level of intervention, it will be less effective.”

Kelman’s point is a caution for those who think that a spiritual approach to healing is simply to give out vitamins or to eat organic. That may be an important part, but what is also needed is a certain kind of consciousness. There are some new health care practitioners who present themselves as “alternative” because they don’t use traditional medicine, but who nevertheless approach health in a mechanistic way. The alternative I am recommending may include some of these new methods as well, but must include the isses of meaning and spiritual practice.

Consider, for example, the question of what we take into our bodies and how to do that in a spiritual way.

When people see that food is an act of giving on the part of the earth and that we have a corresponding need to give back, they begin to approach a spiritual level of understanding. So,eating foods that are products of exploitation of the earth or that were produced through alienated labor that was wildly underpaid and demeaned has negative health consequences. As Kelman puts it, “The earth gives to us so that we can give in turn to others–because we are all fundamentally interconnected and interdependent. Our atoms are constantly being shuffled from the earth and the air through us and back to a tree or to other human beings or to the earth. There is a constant dance of sharing that is occurring, but when we block this whole cascade through fear or greed, we interfere with the life-giving and nurturing qualities that are available and were meant to sustain us.”

We return, here, to one of the core points in this book: We have lost our sense of wonder and appreciation. Awe and wonder must be part of our process of eating, and if they are not, their absence will have adverse health consequences.

So part of a spiritually-oriented medicine is that a doctor must try to instill an understanding of the integrated nature of our health–that on the one hand the health of one part of our body is linked to the health of other parts, and on the other hand that the health of the body is linked to health of the economic, political and ecological systems outside the body. Then, the doctor must support the patient in developing a meaning-orientation towards life, and encourage the patient to activate the capacity for compassion and the deepest connectedness between people (because it is in those moments that the deep healing begins). The initial taking of a history would include these dimensions, and yearly check ups would also address the entire life situation of the patient. When they begins to think in these terms, many doctors will find that they have much to learn from their patients about the various levels of interaction between health and other aspects of life.

The underlying point here is that the reality of each part of our bodies and of the total body is that they are rooted in a much larger totality, a spiritual/emotional/intellectual/physical unity, and that all work together. Spirit Matters–and one dimension of our health problems lies with our inability to really understand the full implications of this body-mind-spirit embodied unity that is who we are.

Try the following exercise in your own life, and you’ll reap many benefits: As you sit down to eat, stop and give yourself three minutes to contemplate the goodness of the universe which has supplied you this food. Bless the food and all who have contributed to the causal chain which brought the food to your table. Then, take ten minutes in the middle of the meal to eat in silence. Focus on the tastes. Chew slowly, and be aware of each movement of your tongue and teeth as you chew the food. After the meal, spend three minutes of silence with a focus again on thanking he universe for the food, and on renewing your commitment to spend time and energy to ensure that all those who do not have enough to eat will be given food.

If we can get ourselves to slow down in this way, and respond to the world with awe, wonder and radical amazement, we will certainly develop a healthier attitude. This kind of attention and consciousness will eventually become more prevalent and will contribute to a more healthy world.

None of this is to suggest that we abandon drugs or other forms of high-tech medicine. It is a plea, however, to open up our understanding of what can be healing in meaning.

A First Step

Make it a legal requirement that doctors take a “meaning/spiritual” history when they do their intake and examinations. This information will soon be shown to predict health or disease, and that could lead to a deeper attention to meaning and the spiritual development of patients.

Require that part of the continuing education of the profession is a course that encourages doctors and nurses to allow themselves to be utopian, to fantasize, to imagine, to be creative in envisioning the kinds of changes they would like to see in their own profession. Let doctors and other health professionals learn that Spirit Matters: health care and medicine could look very different if we had a new bottom line of love and caring, a new sensitivity to the world of spirit. As the new spiritual awakening deepens in the coming centuries, we will see fundamental transformations in the way we do healing and health care. Doing this kind of envisioning, seemingly utopian at first, will free doctors to do the kind of thinking they were never taught to do in medical school–and could be the beginning of a very significant transformation in medicine. To make this all real, we need a core group of physicians and other health care professionals to become the leadership in creating a Transformative Medicine campaign incorporating and educating others to this vision. If you are such a professional, or know others who are, please copy and send this link to them and urge them, if they agree with this vision, to contact Cat@catjzavis.com who is the executive director of the (interfaith and atheist-and-secular-humanist-welcoming) Network of Spiritual Progressives (check us out at www.spiritualprogressives.org). You don’t have to be religious or believe in God to be a spiritual progressive–only want a New Bottom Line in which our corporations, government policies, and public institutions (education, health care, judicial system, economic system) are judged “efficient, rational, productive” not only to the extent that they maximize money or power, but also to the extent that they maximize love and caring, kindness and generosity, environmental sustainability and repair, ethical behavior, and enhance our capacity to respond to the universe with awe, wonder and radical amazement and the grandeur of the universe. To get a fuller understanding of the Network of Spiritual Progressives, please read our website at www.spiritualprogressives.org

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